This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, March 09, 2013

Weekly Overseas Health IT Links - 9th March, 2013.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Quietly, with almost no headlines, Skype has revolutionized the practice of psychiatry and psychology.

Doctors all over America are now meeting with their patients via Skype, instead of in person. And this may be just the beginning.

Skype has folded down the walls of psychiatrists’ offices. It is allowing patients who previously would not have had access to talented mental health professionals in states far away from them, or to those literally in other countries, or to those 100 miles away, to choose from many of them.

It has dissolved some of the resistance to getting help from people who were loathe to drive an hour to see their therapists, then spend another hour talking, then drive an hour back to work or home. Now, they can turn on their laptops, sit in their offices or living rooms and get to the bottom of what is limiting them.

HASBROUCK HEIGHTS, N.J. — Despite all the promises of e-prescribing, in the land of the newfangled, the old-fashioned still reigns supreme, according to a new study.

The study, by point-of-prescription advertising company MediScripts, found that handwritten prescriptions continued to outpace e-prescribing by more than 60% in 2012. The company said the high volume of MediScripts prescription pad use demonstrated continued physician preference for pen and paper, but use of electronic medical record software has shown increased uptake.

Hacking into patient medical records can be as easy as tapping into a hospital's unsecured wireless network from a laptop in the parking lot.

Government auditors proved it "by sitting in hospital parking lots with simple laptop computers" and obtaining "patient information from unsecured hospital wireless networks," according to Julie K. Taitsman, M.D., J.D., and colleagues from the Office of the Inspector General at the Department of Health and Human Services (HHS).

"Healthcare providers should follow best practices to ensure that computer networks are more secure," they wrote online in a Perspective piece in the New England Journal of Medicine.

Deloitte, which bills itself as the world's largest health consultancy, and Intermountain Healthcare, known around the world for its pioneering work in healthcare informatics, are teaming up to help transform healthcare. The tools: brain power, experience, new technology and vast amounts of data – two trillion unique medical data elements, collected over 40 years. The goal: sharing the insights derived from mining and analyzing the Intermountain data with physicians, hospitals, manufacturers, vendors and payers across the country.

In a recently forged five-year-deal, announced February 28, Deloitte and Intermountain will work together to tap the data Intermountain has accumulated – going back to the1970s. Because of the longitudinal nature of the clinical and financial data amassed from Intermountain’s 22 hospitals and 200 clinics, it is particularly effective for medical studies and analyzing optimal treatments for many health conditions, the partners say.

When it comes to healthcare analytics, hospitals and health systems can benefit most from the information if they move towards understanding the analytic discoveries, rather than just focusing on the straight facts.

George Zachariah, a consultant at Dynamics Research Corporation in Andover, Mass., explains the top five ways hospital systems can better use health analytics in order to get the most out of the information.

Adoption of electronic health records continues to make inroads, with six in 10 healthcare providers having at least part of an EHR system in place, according to the fourth annual "Healthcare IT Insights and Opportunities" survey from IT trade association CompTIA. Still, satisfaction with most systems is lacking.

CompTIA polled 375 doctors, dentists and other care providers, and found a satisfaction rate averaging in the low 60s – indicating "acceptable performance," but leaving much room for improvement, researchers say.

Among their complaints, providers say they want better ease of use, improved interoperability with other systems, faster speeds, more vendor training and improved remote access and mobility features.

The researchers, whose work was published this week in BMJ, followed more than 1,500 patients suffering from chronic obstructive pulmonary disease, diabetes or hear failure over the course of a year who used telehealth, as implemented by the Whole System Demonstrator Evaluation. They found that, when compared to patients who received regular care without telehealth equipment, there were no significant improvements in reported quality of life or anxiety or depression symptoms.

Some researchers worry that the project lacks clear goals and, with possible sequestration looming, could consume money that could fund a series of smaller projects, according to an article in The Atlantic. University of California-Berkeley biologist Michael Eisen, for one, has argued against such so-called "Big Science" projects since his involvement with the huge "junk" DNA research project ENCODE, the article says.

We all have social security numbers, driver’s license numbers, and financial identification numbers that help standardize many of our most vital interactions and trace our activities back to a single, authorized source. We even use our email addresses, Facebook accounts, and Twitter handles to establish our identities in the virtual world, and most of those use passwords that aren’t anywhere near as secure as we think. So why don’t we have a national patient identification (NPI) number that ties us to the most important aspect of our lives: our health?

Meg Aranow, Principal at Aranow Consulting, LLC, thinks we should. Writing as a guest on Life as a Healthcare CIO, a popular blog by Dr. John Halamka, Aranow feels that the privacy risks are outweighed by the rewards of a single ID number to unify clinical records, especially as more and more providers join health information exchanges and EHR information is shuttled back and forth across disparate systems.

Ordering medications through a computerized provider order entry (CPOE) system decreases the likelihood of medication errors by 48%, according to a new paper in the Journal of the American Medical Informatics Association. Projected nationwide, this means that CPOE averted about 17.4 million errors in 2008, the year of the study. However, the authors note, "It is unclear whether this translates into reduced harm for patients."

The study included a meta-analysis of nine papers that compared the medical error rates in hospitals before and after their adoption of CPOE. In addition, the researchers used national data on CPOE prevalence, medication ordering and medication errors for 2008, or data that were deemed reflective of that year.

Physicians are interested in electronic sharing of health information, but their awareness of and adoption of health information exchange varies significantly based on practice size, according to a new report released by the Office of the National Coordinator for Health IT.

The report, prepared by NORC at the University of Chicago for ONC, conducted focus groups with 68 physicians in five states. The researchers found that 55 percent of physicians in smaller practices had some expertise with exchanging clinical data electronically, such as e-prescribing, compared to 76 percent of large practice physicians.

An EHR-based model was more effective in predicting intensive care unit cardiopulmonary arrest or death than prior risk models, including one based on human judgment, according to a study published at BMC Medical Informatics and Decision Making.

The study, from Parkland Hospital in Dallas, looked at predictors for cardiopulmonary arrest, acute respiratory compromise and unexpected death, known as RED events, using data from the previous 24 hours. That data included vital signs, laboratory data, physician orders, medications, high-risk floor assignment, and the Modified Early Warning Score (MEWS), among other treatment variables.

Today we're publishing two issues of FierceHealthIT. In this special edition, we preview next week's Health Information and Management Systems Society's annual conference in New Orleans--the big daddy of all things health IT.

We are well-aware that your inboxes are loaded--I know mine is--but I hope you'll enjoy and find value in both editions of FierceHealthIT today, whether you're attending the show or not.

Diagnostic errors can trigger unplanned hospitalizations, return visits or ER visits and put patients at greater health risk. More reviews of EHRs could help providers address the breakdowns causing missed, delayed or wrong diagnoses, according to a JAMA Internal Medicine study published on Feb. 25.

Breakdowns occurring during the patient-practitioner clinical encounter account for the majority of these errors, and relate to problems with history taking, examination and ordering diagnostic tests for further workup. “Most errors were associated with potential for moderate to severe harm,” the authors stated.

A 2005 RAND report predicted that widespread use of electronic health records technology would save the US healthcare system at least $81 billion per year. At the time, the vendor-funded report helped drive substantial growth in the electronic health records industry and probably contributed to the federal government making billions of dollars of incentive payments available to physicians and hospitals to adopt and meaningfully use electronic health record (EHR) systems via the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Realizing that the cost savings and improvements in healthcare delivery are nowhere near what was optimistically predicted in 2005, RAND recently commissioned a new study to take a fresh new look at the state of health information technology. The new study paints a very different picture and received broad coverage by mainstream news outlets, including “In Second Look, Few Savings From Digital Health Records” by the New York Times in January.

“We’re maturing from HIE 1.0 to HIE 2.0,” Micky Tripathi proclaimed. “We’re in a new world now.”

A raft of technologies including broadband, cloud computing, cheaper storage, and mobile devices, among others, is driving the transformation. At the same time, market expectations regarding standards of care are changing, as are younger providers’ relationship with health-specific IT. All those factors are also sparking the move toward decentralization and a bottom-up phenomena in which consumers begin asking for electronic access and for those records to be shared across providers.

Another “of the things that’s driving [HIE 2.0] is the limited success of the prior model,” Tripathi, CEO of the Massachusetts eHealth Collaborative and chairman of the ONC information exchange working group (IEWG) said during his "The State of HIE" keynote before a rare joint meeting of the HIT Policy and Standards committees January 29. “There have been pockets of deep success, but it hasn’t been uniform, and those have been real pockets of success with a lot of hard work to get them going.”

Adoption of publicly available public health records by consumers has been low due to concerns about data security and accuracy. A possible solution to this is explored in the Journal of Medical Internet Research in an article titled: "If We Offer it, Will They Accept? Factors Affecting Patient Use Intentions of Personal Health Records and Secure Messaging."

The solution, presented by doctors from Fairfax, Va., and researchers from the Center for Health Information and Decision Systems at the University of Maryland, involves the provision of PHRs by employers pre-populated with patients' health data. This type of technology increasingly is being offered to employees "as a mechanism for greater patient engagement in health and well-being," according to the authors.

Perched by a computer monitor wedged between shelves of cough drops and the pharmacy in a bustling Walmart, Mohamed Khader taps out answers to questions such as how often he eats vegetables, whether anyone in his family has diabetes and his age.

He tests his eyesight, weighs himself and checks his blood pressure as a middle-aged couple watches at the blue-and-white SoloHealth station advertising "free health screenings."

"You may not go to the doctor every year, but you come to Walmart often," says the fit-looking 43-year-old Khader who lives in nearby Ashburn, Va. "I get bored while my wife is shopping. This is a time killer. I’ll come back in two months or so, and track my results."

Online network PatientsLikeMe has been awarded a $1.9 million grant from the Robert Wood Johnson Foundation to create what the organizations touts as the "world's first open-participation research platform for the development of patient-centered health outcome measures."

The platform is part of a new open-science initiative that puts patients at the center of clinical research process in order to make it possible for researchers to pilot, deploy, share and validate new ways to measure diseases. The initiative will be spotlighted today at TED2013 in a presentation by Paul Wicks, PatientsLikeMe's research director and a new TED Fellow.

Scott Mace, for HealthLeaders Media , February 26, 2013

They call New Orleans the Big Easy, and next week's Healthcare Information and Management Systems Society conference, March 3-7 at the Ernest N. Morial Convention Center, will be a chance to enjoy that unique city's style and grace.

But while some will hear a funeral dirge for the way healthcare used to be, others will detect the romping, stomping, second-line beat of technology-fueled change.

It will be big: Former President Bill Clinton will be a keynote speaker, as will political heavyweights Karl Rove and James Carville. As of this writing, I've already been contacted by 152 technology vendors and service providers asking to meet with me at the show.

Health insurer Aetna, which has acquired and created a portfolio of health IT companies in recent years, has rolled its IT, population health management, and business incubation assets into a new business unit called Healthagen. The goal, according to the Hartford, Conn.-based company, is to have a common brand for addressing provider and consumer needs in the areas of care coordination, value and greater transparency in healthcare.

The new business unit includes such Aetna holdings as mobile app iTriage, analytics and population health services company Active Health Management, health information exchange provider Medicity and home-grown physician workflow transformation tool Practice iQ. The Healthagen name comes from the developer of iTriage, which Aetna bought in 2011.

The sixth Global Information Security Workforce Study, conducted by (ISC)² shows that a shortage of information security professionals is having an adverse impact on healthcare and other industries, even as vulnerabilities such as mobile devices and social media are on the rise.

The (ISC)² study, conducted in partnership with Booz Allen Hamilton and Frost & Sullivan, examined security practices across many industries. One of its key findings is that more than two-thirds of chief information security officers say they're short-staffed – leading to an increased threat of expensive breaches.

"Now, more than ever before, we’re seeing an economic ripple effect occurring across the globe as a result of the dire shortage of qualified information security professionals we’ve been experiencing in recent years," said W. Hord Tipton, executive director of (ISC)² in a statement.

To answer that, the Office of the National Coordinator for Health IT and the Arizona Strategic Enterprise Technology office seperately conducted surveys of providers HIE perspectives and the research produced similar findings.

What does the average American doctor think about available health information exchange technologies several years into the meaningful use program?

To answer that, the Office of the National Coordinator for Health IT and the Arizona Strategic Enterprise Technology office seperately conducted surveys of providers HIE perspectives and the research produced similar findings.

The Office of the National Coordinator for Health Information Technology has launched a self-paced education module on the "transitions of care" from both a meaningful use and electronic health record technology certification perspective.

Two University of Southern California scientists have created an algorithm to bring gene sequencing closer to clinical use.

The declining cost of gene sequencing, paired with advances in computing power have raised the possibility of more widespread use of genomics to provide personalized medicine. So far, though, cost has been a huge barrier.

The new algorithm, described in the journal Nature Methods, helps researchers determine how much DNA to sequence--enough to get the answer, but not too much that would waste time and money.

As data sets have grown exponentially, new thinking has been required about the mathematical properties of DNA sequencing data, the authors say in an announcement. Their method allows researchers to predict how much can be learned in a large-scale DNA sequencing experiment.

The current shift in the healthcare industry to digitize care unquestionably is the biggest shakeup in the history of medicine, according to cardiologist Eric Topol, a professor of genomics at The Scripps Research Institute in San Diego and author of "The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care." Still, Topol (right) says, the industry has a ways to go before it will be able to shake its "slow moving" reputation; the public, he adds, will be key to driving that change.

"We need to take initiative and ask our physicians why they're using old tools or sending us for outdated tests," Topol, who is slated to give the Tuesday, March 5 keynote address at HIMSS13 in New Orleans, tells FierceHealthIT in an exclusive interview. "We need to tell our doctors that we don't want to be in the dark, getting some cookbook recipe for care of one kind of disease or another."

There is no shortage of online reviews for anything from hotels to restaurants, electronics to clothing. If you want to know what others think of the product or service you're about to buy, there's a good chance you'll find plenty of opinions on the Internet.

Health care consumers, however, don't have the same access to information about their doctors.

"People want that kind of information," Maryann Napoli -- associate director of the Center for Medical Consumers in New York City -- said. But access to meaningful data presented in a consumer-friendly way about how doctors perform isn't readily available to the public, according to Napoli.

Because healthcare IT is expensive. And the report reveals that it's becoming an ever bigger drain on hospital and health system bottom lines. And that an ROI from healthcare IT will be hard to find, despite the fervent hopes of healthcare executives.

Today, 40% of the 250 respondents say the operating IT budget takes up 2-3% of their organizations' overall operating revenue. But the respondents—who represent a range of C-suite leaders and VPs, including CEOs, CFOs, COOs, and CIOs—expect an upward shift in the near future. More than half (56%) say the operating IT budget will account for 4% or more of overall operating revenue, and a fifth expect IT spending to take 6% or more.